Psychiatrist in Pune , Dr Neville Misquitta (MD Psychiatry). This is a psychiatrists take on Pune occurrences. Mental health issues reflect underlying universal problems that keep some of us from a meaningful life. At Pathfinder Clinic we make the link.

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Saturday, April 30, 2011

Exercise addiction - distorted pursuit of attractiveness?

Overexercising - obsessive weight-lifting or running, compulsive gym routines, or psychological dependence on exercise - is an illness. The health and fitness benefits of exercising are undeniable. However by overexercising the distorted pursuit of attractiveness takes precedence over fitness. Exercise addiction indicates a body image disorder; a distortion of the individual's mental representation of his or her own body. When I first commented on this phenomenon in 2001 body image disorders were a rarity in India (Misquitta 2001).

Pune is fascinated with its physique. Witness the mushrooming gyms and spas in every neighbourhood. Men dissatisfied with their appearance throng them to reduce or gain weight in pursuit of an ideal muscularity depicted on huge sports hoardings. An 18 year old ‘hunk’ is ashamed to wear T-shirts convinced his pectorals are too thin. He has no time to left to socialise at the end of his daily 5-hour workout. Women join gyms to lose weight and attain a waif-like slenderness. A 23 year old is advised by her trainer to cut down on her punishing exercise regimen - she changes her gym and continues to lose further weight. Exercising is no longer about fitness - it's about beauty.

From an evolutionary perspective attractiveness has universal criteria. These serve as cues to a persons reproductive ability. Males and females select partners that will enhance their reproductive success. Body characteristics signal reproductive advantage and render one individual more ‘desirable’ than another

Males desire muscular mesomorphism - the ideal body shape of broad shoulders, a muscular stomach, chest and shoulders, and a thin waist. This usually means about 10kg more muscle and 4kg less fat than their current physique. Positive characteristics of strength, bravery, health, and good looks are associated with this physique. Males also feel that looking fit is essential to career advancement. This discrepancy between actual physique and the desired culturally ‘ideal’ muscular physique is pushed at us from magazine covers, movies, posters, and toys (Todd G 2006).

For women body image is related to weight rather than shape (Viren Swami 2006). Urbanisation has placed unprecedented opportunities and demands on women. Slim women are used by the media to portray desirability. These socio-cultural demands have altered the evolutionary ‘hour-glass’ ideal for women. The emphasis is on slender and glamorously adorned women, striving for career accomplishment while maintaining their attractiveness. Increase in affluence also brings with it an epidemic of obesity that legitimises the pursuit of thinness and fear of fatness. Women exercise to lose body fat and improve muscle tone without increasing muscle mass.

Exercising is distorted into a pursuit of attractiveness for some individuals. These individuals pump iron, creatine, and steroids if they are males; or run and starve themselves if they are females. They lose their sense of perspective. Their bodies turn grotesque or gaunt. But when they look in the mirror they see some more work that requires to be done on some particular body mass.

At this stage they have developed body image distortions. Experiments have consistently shown that high mileage runners have a distorted perception of body size, they overestimate their waist size as compared to recreational runners (Wheeler 1986). Overexercising males who join gyms to increase muscle mass, and underweight females who overexercise are more likely to have body image disorders (Sergia-Garcia 2010). These body image disorders include anorexia nervosa in females and muscle dysmorphia (reverse anorexia or bigorexia) in males.

Muscle dysmorphia in males is the end stage of excessive exercising for muscularity (Pope 1997).

Preoccupation with the appearance of the body

Concern with not being sufficiently large or muscular

Persistent weight lifting and dieting

Anorexia nervosa in females is the result of excessive exercising for slimness.

When should you suspect a body image disorder in an exercise freak (James E Leone 2005)?

Excessive and inordinate time is spent on grooming and appearance. The exercise is done with the aim of enhancing appearance rather than performance. When the person is not exercising he or she spends time being worried, depressed or anxious about appearance

Avoidance of social and work obligations either due to a sacrosanct exercise schedule or embarrassment due to perceived deformities in appearance

Dieting, supplements and drugs to enhance physical appearance. A large proportion of income could go towards this